Prognostic significance of residual lymph node status after definitive chemoradiotherapy in patients with node-positive cervical cancer

Abstract Objective Lymph nodeinvolvement is an important prognostic factor in patients with cervical cancer. However, the prognostic significance of lymph noderesponse to chemoradiotherapyremains unclear. We retrospectively analyzed the relationship between residual lymph nodestatus after definitive chemoradiotherapyand survival. Methods We enrolled 117 patients with node-positive cervical cancer. All patients were treated with definitive chemoradiotherapyin our institution, from 2006 to 2016. The median follow-up period was 41months (range, 6–128months). The criterion for a positive lymph nodewas defined as a maximum short axis diameter of ≥8mm on pretreatment magnetic resonance imaging (MRI)/computed tomography (CT) scans. Posttreatment pelvic MRI was obtained 3months after the completion of chemoradiotherapy. Residualprimary tumor was defined as any residuallesion identified upon clinical examination and/or MRI. Residual lymph nodewas defined as any lymph nodewith a short axis diameter of ≥8mm posttreatment, according to MRI/CT. Results At follow-up, 3months after chemoradiotherapy, we observed residualprimary tumor in 30 patients (25.6%), and residual lymph nodein 31 patients (26.5%). The presence of residual lymph nodewas associated with worse overall survival according to multivariate analysis (hazard ratio, 3.04; 95% confidence interval, 1.43–6.44; p=0.004). In the 5-year time-dependent ROC analysis of survival prediction, the presence of residual lymph nodeshowed an AUC value of 0.72. Conclusions The presence of residual lymph nodeafter chemoradiotherapywas associated with worse survival in patients with node-positive cervical cancer.